Maryland Primary Care Program: Behavioral Health ... · PDF file • Zivin K, Miller BF,...

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Transcript of Maryland Primary Care Program: Behavioral Health ... · PDF file • Zivin K, Miller BF,...

  • Maryland Primary Care Program: Behavioral Health Integration

    Registry and Data Sharing

    Program Management Office

  • What do we mean by Behavioral Health?

    • Mental health and substance use disorders

    • Focus on most common and most harmful diagnoses in the primary care setting:

    • Mental health – in particular depression and anxiety

    • Substance use disorders – in particular alcohol and opioids

    2

    Behavioral Health Integration

  • Why Behavioral Health Integration?

    • Often overlooked

    • Frequently worsens co-morbid conditions

    • Few existing programs in primary care

    • Opioid Crisis- 4th leading cause of death in Maryland

    • Frequent cause of avoidable ED and Hospital admission

    • Emergency room visits in Maryland fell 8 percent from 2013 to 2016, but the number of patients with behavioral health problems jumped 18.5 percent. Such cases now make up roughly a quarter of all emergency visits in Maryland.

    • Key feature in MDPCP and required to move to track 2

    3

    Behavioral Health Integration

  • Overview of Series

    1. Overview

    2. Build your team

    3. Choose what’s best for your practice

    4. Establishing workflows for treatment and referral

    5. Recruiting Resources

    6. Registry and Data

    7. Collaborative Care Model

    8. SBIRT and MAT

    9. Coding and Billing

    4

    Behavioral Health Integration

  • BHI Overview

    5

    Behavioral Health Integration

    Screening (universal)

    •Registry creation/maintenance

    •Risk stratification

    Treatment

    •Counseling – Behavioralist

    •Medication – Clinician

    •Coordination – Care Manger

    Referral (as needed)

    •Psychiatry

    •Addiction Specialist

    • Coding and billing • Communication

    across providers • Quality assurance

  • BHI Overview

    6

    Behavioral Health Integration

    Identification Of

    Focus Area

    Screening

    Process and tool

    Registry creation and maintenance

    Prioritization

    In workflow

    Risk stratification

    Based on scores

    Priorities for CQI

    initiatives

    Communication

    Across providers

    Behavioral Health Clinical

    Care Team

  • BHI Team

    7

    Behavioral Health Integration

    BHI Team

    BH Care Manager

    Lead

    Behaviorist

    LCSW

    Psychologist

    Counselor

    Biller

    Coder

    Lead Clinician

    and Providers

    Psychiatrist

    Optional CTO Support

  • Why a Registry for BHI

    • Track clinical outcomes across a target population and individual Patients

    • Facilitate and track patient and care team/provider engagement across internal and external care settings

    • Prompting of administrative tracking:

    Behavioral Health Integration

    8

  • Key Registry Functions

    9

    Behavioral Health Integration

    •Population-level reports based on screening

    •Monitor workloads and progress

    Track Clinical Outcomes Across Target Population

    •Appointment, Referral, Engagement Reminders/Alerts Track Patient Engagement Across Case Load

    •Treatment adjustments based on clinical outcome measures

    •Real-Time recent values and dates of measurements

    Prompt Treatment to Target

    •Caseload/Care Plan Reports sorted and/or filtered by screening results

    •Tracking previous case review

    •Ability to manually flag patients for mental health/addiction consults and review

    Facilitate efficient, systematic care review

    •Patient level real-time reports displaying summaries of treatment history over time

    •Baseline assessment data report comparisons

    •Flowsheet/graphical views of assessment scoring/symptoms/treatments/medications Monitor patient progress

  • Data Inputs for Registry

    • Diagnosis

    • Medications – psychotropic

    • Assessment values/scores and cut-off determinations

    • Clinical Quality Measure data elements per requirements

    • Level of Suicide Risk

    • Referrals to treatment or specialty services

    • Key Service Dates

    • Treatment Status categories • Enrolled in program but no contacts with provider to date

    • Active treatment phase – regular contact wit provider

    • Relapse prevention plan – completed active treatment phase likely to graduate/discharge

    • Discharged or graduated from program

    • Episodes of care • Target treatment goals based on episode (depression, substance use)

    • List of contacts/contact attempts with provider name, mediation at visit, dosage, screening scores

    10

    Behavioral Health Integration

  • Example Registries

    • Independent tracking document (spreadsheet) as interim solution or in collaboration with EHR • If no EHR has been implemented, this can be used until one is available at the

    Practice • If EHR is in use, data elements from • Must ensure same safeguards and HIPAA protections are in place as you would

    for any other PHI

    • Standalone Case management/CaseLoad application in collaboration with EHR • Clinical activities documented and tracked within independent system must be

    uploaded/input into EHR for effective care collaboration across multidisciplinary care teams

    • Customized/Canned registry build within the EHR/EMR itself

    11

    Behavioral Health Integration

  • Example of Spreadsheet Patient Tracking

    12

    Behavioral Health Integration

  • Caseload Overview/Review

    13

    Behavioral Health Integration

  • Statistics/Report

    14

    Behavioral Health Integration

  • Billable Time

    15

    Behavioral Health Integration

  • Online Registry - APA

    • PsychPRO: American Psychiatric Associations Registry: • EHR Integration with many EHR systems

    • Supports NQF0004, NQF0018 (High Blood Pressure)

    • Integrated Patient Portal

    16

    Behavioral Health Integration

  • Online Registry

    17

    Behavioral Health Integration

  • Online Registry

    18

    Behavioral Health Integration

  • Registry Team

    • Implementation Leader: • Identify workflow needs, screening tools, data input/outputs, reports, system requirement and

    integration with EHR, coordinate project roll out, identify Team

    • BH Care Manager • Central to Registry • Leads Care coordination, data exchanges between internal and external team, coordinate/follow

    through with referrals, updating EHR

    • PCP • Focus on treating patient, reviewing registry data/EHR, part of care coordination treatment

    planning

    • Psychiatric Consultant or Behaviorist within Practice • Reviews data elements(screenings, referral, medications, treatment HX) • Makes recommendations for treatment • Ensures necessary communication/data exchanges occur between Care Manager/Practice and

    Registry/EHR

    19

    Behavioral Health Integration

  • BH Care Manager- Central to Registry

    20

    Behavioral Health Integration

  • BHI Registry Overview

    21

    Behavioral Health Integration

    Identification

    Patient Identification

    Alignment of CQI workflow/requirement

    Screening Tools and scoring

    Prioritization

    Risk stratification based on reports/output from

    Registry

    Care Manager/ Team

    Review

    Plan for Treatment Intervention/ Referral

    Refer/Treat

    Workflow for frequency of Data

    exchange

    Workflow for frequency of Care

    Coordination

    Ongoing Review and coordination of

    Treatment Status

    Track/Report

    Real-time provider/clinic stats

    CQI

    Tracks minutes/time for CPT and G-code

    billing

  • Thank you!

    Behavioral Health Integration

    Updates and More Information:

    https://health.maryland.gov/MDPCP

    Questions: email [email protected]

    22

    https://health.maryland.gov/MDPCP mailto:[email protected]

  • Select References

    • “CPC+ Behavioral Health Integration Requirement – 2019. “ Center for Medicare and Medicaid Innovation. October 2018.

    • Unutzer, Jurgen. “Which Flavor of Integrated Care?” Psychiatric News. Oct 16, 2014. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2014.10b25. Accessed October 18, 2018.

    • “CoCM Behavioral Health Care Manager: Sample Job Description, Typical Workload & Resource Requirement.” AIMS Center, Unviersity of Washington Psychiatry & Behavioral Sciences. http://aims.uw.edu/sites/default/files/CareManagerJobDescription_0.pdf. Accessed October 18, 2018.

    • “Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services.” Center for Medicare and Medicaid Services. April 17, 2018. https://www.cms.gov/Medicare/Medicare-Fee-for-S